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What Is Iowa’s Health Insurance Exchange?

Iowa lawmakers set out to establish a state-federal
partnership health insurance marketplace in December 2012. Some states
established a purely state-run marketplace, and others rely solely on the
federal marketplace. Iowa used a partnership at first. By 2016, however, the
Iowa Marketplace will be fully state-based.

Individuals can purchase their own health insurance plans
through the marketplace. Small business owners can purchase a plan for their
employees as well. The Small Business Health Options Program (SHOP) allows
employers with 50 employees or fewer to shop and compare options for their
company.

Participating Health Insurance Companies

As of July 2015, three companies have applied to offer
health insurance plans through Iowa’s marketplace. Some will offer individual
plans only. Some will offer plans for small businesses only.

These companies include:

Coventry Health Care of Iowa

Medicaid

UnitedHealthcare

Iowa’s largest health insurance provider, Wellmark Blue
Cross and Blue Shield is not part of the exchange.

What’s Covered?

By law, all health insurance plans offered through a
federal- or state-run exchange must cover the following 10 essential services:

Plans

You may be eligible to buy one of five different types of
health insurance plans through Iowa’s Marketplace. Each type of plan offers
varying levels of expense for premiums, deductibles, copayments, coinsurance,
and out-of-pocket maximums.

These five levels of health insurance are:

Platinum: Your plan covers 90 percent; you pay
10 percent.

Gold: Your plan covers 80 percent; you pay 20
percent.

Silver: Your plan covers 70 percent; you pay 30
percent.

Bronze: Your plan covers 60 percent; you pay 40
percent.

Catastrophic: These plans pay less than 60
percent of your costs in a year and are designed to be used only in the event
of an emergency or catastrophic event. They’re only available to people under
the age of 30 or those who qualify for a special exemption.

You’ll use the federally run Healthcare.gov portal to apply
for these insurance plans. Once you apply, you’ll be able to compare your
options.

The application process will also help you determine if you’re
eligible for Iowa’s Medicaid program. Medicaid is a health insurance program
for low-income individuals and families. If you qualify for Medicaid, you will
finish applying for that type of insurance rather than continuing your
application through the marketplace.

Costs

Your health insurance rate will be based on your age,
history of tobacco use, and your geography. Iowa is divided into seven
geographic rating areas. People living in different geographical regions may
pay different prices for the same metal (bronze, silver, gold, or platinum) level.

According to the Kaiser Foundation’s Health Insurance
Marketplace Calculator, a 30-year-old Iowa resident who does not use tobacco
can expect to pay an average of $275 per month for their insurance premiums.
That does not factor in any financial assistance from subsidies or tax credits.

Credits and Subsidies

When the Affordable Care Act, also known as Obamacare, was
established, it set up a system for financial aide. This financial aide is
designed to help individuals offset the cost of their health insurance
premiums. These subsidies and tax credits are determined based on financial
need. Not everyone will qualify.

You may qualify for lower premiums if your annual income
falls within a certain range. These ranges include:

$11,670 to $46,680 for 1 person

$15,730 to $62,920 for 2 people

$19,790 to $79,160 for 3 people

$23,850 to $95,400 for 4 people

$27,910 to $111,640 for 5 people

$31,970 to $127,880 for 6 people

You may qualify for lower premiums and lower out-of-pocket costs
if your annual income falls within a certain range. These ranges include:

Signing Up

The 2016 annual open enrollment for Iowa starts November 1,
2015. If you miss the open enrollment period, you may be eligible to apply for
insurance during a special enrollment period.

If you need assistance during your application process, you
can submit a request for an enrollment specialist to contact you. Also, Iowa
utilizes the federally run Navigator program to help consumers find the
assistance they need.

Don’t let the open enrollment period pass you by without
applying. Being insured is now law. If you don’t have health insurance, you may
face fines and penalties. So no matter your current health or your previous
experience trying to buy individual health insurance, you need to apply. That’s
the only way you’ll ever know what you may be eligible to buy.